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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803698
Report Date: 03/27/2024
Date Signed: 03/27/2024 03:39:00 PM


Document Has Been Signed on 03/27/2024 03:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:VINEYARD AT FOUNTAINGROVE, THEFACILITY NUMBER:
496803698
ADMINISTRATOR:JOSEPH HANSENFACILITY TYPE:
740
ADDRESS:200 FOUNTAINGROVE PKWYTELEPHONE:
(707) 544-4909
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:64CENSUS: 48DATE:
03/27/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Christina Cruz, Marketing Dir/Assist. EDTIME COMPLETED:
03:45 PM
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Licensing Program Analyst’s (LPAs) Hansen & Florio arrived unannounced on this day 3/27/2024 to conduct a Case Management -Plan of Corrections (POC) visit. LPA's met with Marketing Director/Assist. ED Christina Cruz.

On 2/20/2024 LPA conducted a case management visit and toured facility with Administrator Joe Hansen. During tour at approximately 2:30 pm it was observed hallway fire doors could not shut on their own. Administrator informed LPA the hallway fire doors are malfunctioning due to broken magnetic devices to hold them open and close them if there was a fire. Facility was cited for regulation 87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. POC due date was 3/20/2024.

On today’s (3/27/2024) LPA’s and Assist. ED toured facility at aprox 2:00pm and observed multiple internal fire doors wedged open with door stops. Assist. ED informed they had not been fixed yet but is in communication with repair company and could not provide scheduled appointment confirmation.

Licensee has not corrected the POC’s by the due date. Civil Penalties issued.

Civil penalties are being assessed today in the amount of $700.00 for failure to correct POC and will continue to run at $100.00 per day until corrected.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided..
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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